Acute Poisoning

Arsenous acid is frequently used as a poison. The forms most employed are Scheele's and Paris Green (cupric arsenite), and Schweinfurth's Green (a compound of cupric arsenite and arsenate). Symptoms. - Soon after taking it the sufferer experiences faintness, nausea, sickness, epigastric pain and tenderness. These symptoms quickly increase. The vomit is brown, and often streaked with blood; the pain is very severe; there is profuse diarrhoea, with much tenesmus; and there are cramps in the calves of the legs. The vomiting becomes violent and incessant; there is a burning sensation in the throat, with intense thirst. Soon severe symptoms set in; the skin is cold, the pulse small and feeble, and the patient dies in collapse. The symptoms frequently bear a close resemblance to those of cholera. Post-mortem. - The stomach is intensely inflamed, even if the arsenic has not been taken by the mouth, but has been applied in large quantities to cancerous growths. This shows that arsenic is excreted from the blood into the stomach. The small intestines are also acutely inflamed.

Treatment

Wash out the stomach. Give emetics (see p. 139), choosing the least irritating and least depressing. The stomach must be completely emptied. Give unlimited quantities of freshly prepared humid ferric hydrate (see p. 193) or dialyzed iron. If neither of these is handy, give magnesia in large amounts, or large doses of castor oil and water. Give brandy or ether subcutaneously; apply hot blankets and bottles to the feet and the abdomen.

Chronic Poisoning

Often, when arsenic is taken as a medicine, slight symptoms of poisoning are seen. They are loss of appetite, nausea, perhaps vomiting, slight abdominal pain, and mild diarrhoea. The eyelids become a little puffy, the conjunctivae injected, the eyes and nose water, and there is slight headache. These symptoms, of course, show that the dose given is too large, and that it must be decreased.

Arsenic is so often used in the manufacture of all sorts of articles, especially wall papers and fabrics, that chronic poisoning by it is frequently seen. The evidence in regard to chronic poisoning from occupancy of rooms decorated with arsenical wall paper is somewhat contradictory, but the facts point towards its probability. Quite as often the poisoning is due to the arsenic which is a contamination of aniline dyes as it is the arsenical pigments, so that the color should not be depended upon, but rather a chemical examinarion. It is also met with in workers of arsenic, and in persons to whom it has been given with intent to murder. The symptoms produced are those already mentioned as present when large doses of arsenic are taken medicinally.

Long-continued use of arsenic may induce peripheral neuritis; the chief symptoms of arsenical neuriris are herpes zoster, paralysis of the muscles of the limbs, especially the extensors of the hands and feet, ataxic gait, severe darting pains in the limbs, and rapid muscular atrophy. Several cases are recorded in which arsenic has caused general brown pigmentation of the skin. It may also give rise to brown pigmentation of patches of psoriasis, and in quite exceptional cases cause eczema or urticaria. After death from chronic poisoning, in addition to the gastrointestinal and nervous lesions, there is widespread fatty degeneration of most of the organs of the body. It is well seen in the liver, kidneys, stomach and muscles, including the heart.

Repeated doses given to animals abolish the glycogenic function of the liver, so that puncture of the floor of the fourth ventricle no longer causes glycosuria. In frogs poisoned with arsenic the epidermis peels off very easily. This is due to degeneration of its lower cells, the degeneration proceeding from the lowest layer outwards.

The tests for arsenic are so simple that every physician should be able to make use of them. They are: (1) Reinsch's. - Hydrochloric acid and a clean slip of copper are boiled in the suspected liquid. Bluish spots indicate the poison. (2) Marsh's. - Diluted sulphuric acid and zinc are introduced into a flask with the suspected liquid. The gas issuing from the tube is ignited and the flame allowed to impinge upon a clean porcelain plate forming a steel-white mirror if arsenic be present; or the delivery tube may be heated when the mirror will be deposited upon it. This mirror is distinguished from that produced by antimony by its solubility in potassium hypochlorite if arsenic is the cause.